Depression Management during the Presence of Pain: An Overview – January 20, 2015 – free full text article
Depression and anxiety are frequently associated with increased risk of medical problems. The severity of these problems varies from persistent pain to severe cardiovascular illness.
The pathophysiology of chronic pain and depression overlap in the noradrenergic and serotonergic pathways.
Antidepressants, especially dual acting which affect both pathways, are a frequent and effective choice of treatment for chronic pain.
The effectiveness of antidepressants for pain has not been proven and many pain patients get zero relief from them, including me.n
Although the coexistence of depression and pain, the treatment differs in terms of depression pain comorbidity and painful symptoms in depression.
The aim of this study is to discover and integrate the data about pain.
Results: We found evidence of a strong relationship between pain perception and depression.
Are they trying to minimize “real pain” by calling it merely the “perception of pain”?
I suspect that depression only alters our perceptions, not the reality, of our pain.
Regardless of the comorbid problem, untreated or undertreated chronic pain has significant physical, psychological, social and financial consequences.
One of the frequent co-morbidity of chronic pain is depression. This coexistence is not astonishing according to the involvement of some common regions of brain and pathways.
This is also not astonishing because pain is a miserable stressful experience that would make anyone depressed after enough years had gone by.
Three categories of chronic pain are recognized:
- neuropathic pain ( the result of a damage or dysfunction either in peripheral nerves or central nervous system),
- inflammatory pain and
- non-inflammatory non-neuropathic pain (also called functional pain).
It may be difficult to identify the painful symptoms of depression and pain syndromes associated with depression. Since the treatment approaches are different, sagacious clinical decision is important for the choice of the treatment.
Alterations of serotonergic and noradrenergic pathways in the central nervous system are the common pathological roots of depression and chronic pain.
Clinically, severe pain at onset of symptoms predicts poor response to the depression treatment.
That’s not surprising (again) considering that pain is a miserable stressful experience.
#Researchers routinely avoid including the actual effects of pain, its misery, its physical torment, and the hopelessness of it being cured.
Seratonin has a unique role in pain pathways. It plays an algogenic (Causing or referring to pain) role in peripheral tissues although it acts as an endogenous analgesic role in central nervous system.
Unfortunately, this paradigm supports the use of antidepressants which inhibit monoamine and serotonin reuptake for the treatment of painful physical symptoms in depression and anxiety.
I find it insulting that they believe our severe excruciating pain could be caused by depression and anxiety. Only mild “aches and pains” magnified from fairly normal conditions are possible from being depressed and anxious.
Dual-acting antidepressants (venlafaxine, duloxetine, milnacipran) have more specific actions on the overlapping pathology of depression and pain
the subtypes of the receptors they interfere [with] may differ leading various analgesic effects. Although some authors do not confirm the difference of their analgesic effects
review of the literature suggests that the efficacy of antidepressants (especially SNRIs) may differ and their action may be disease specific.